The Role of Education in Enabling the Sustainable Development Agenda

Stephanie E.L. Bengtsson, Bilal Barakat, Raya Muttarak

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351390873
• Edition: 1
• Topic: Education
• Subtopic: Educational Policy

The Role of Education in Enabling the Sustainable Development Agenda explores the relationship between education and other key sectors of development in the context of the new global Sustainable Development Goals (SDG) agenda. While it is widely understood that there is a positive relationship between education and other dimensions of development, and populations around the world show a clear desire for more and better education, education remains an under-financed and under-prioritised sector within development. When education does make it onto the agenda, investment is usually diverted towards increasing access to formal schooling, without focusing on the intrinsic value of education as a tool for development within the international development community more broadly.

The authors explore these tensions through a review of literature from a range of disciplines, providing a clearer picture of the relationship between education and other development sectors. The book challenges silo-thinking in the SDGs by exploring how achieving the SDG education targets can be expected to support or hinder progress towards other targets, and vice-versa. Drawing on examples from both low and high income countries, the book demonstrates how 'good' education functions as an 'enabling right', impacting positively on many other areas.

The book's scope ranges across education and development studies, economics, geography, sociology and environmental studies, and will be of interest to any researchers and students with an interest in education and the SDGs.

1
People

Enabling physical, mental, and socioemotional wellbeing

1.1 Introduction

One major criticism of the MDG agenda is that while rapid progress was made in several key development areas, the progress was far from inclusive, with many segments of global society finding themselves excluded, and, in some cases, left further behind in key areas of social development (Kite et al. 2014). When it came to education, for example, enrolment rates in primary education continued to shoot upwards after the adoption of the MDG agenda (particularly in Sub-Saharan Africa, where enrolment nearly doubled), but in 2007, progress stalled at around 90 percent, with the remaining ten percent of children proving extremely hard to reach (UN 2015a). Further, while significant progress was made towards the target of reducing the under-five mortality rate by two-thirds by 2015 (accompanying target for MDG 4), by the time the deadline came around, the international community was still at least 10 years off the target, with 16,000 children under five continuing to die every day in 2015 (most of them from preventable diseases) (UN 2015a). Similarly, MDG 5 on maternal health charted significant progress, but maternal mortality rates, particularly in low-income countries, remained unacceptably high in 2015.

If we return, for a moment, to Raworth’s ‘safe and just space for humanity’ (the ‘doughnut’) discussed in the Introduction, those ten percent of children can currently be classified among the world’s population who are living below the safe and just space’s social foundation line (Raworth 2012). Highlighting one significant difference between the environmental ceiling of the ‘doughnut’ and its social foundation, Raworth argues that while earth-system processes were in a ‘safe’ space before the onset of the industrial era, at no time has the human population all lived in a ‘just’ space, above the social foundation line (p. 8). Sustainable development in environmental terms, therefore, will require us to move back into a safe space, while in social terms, it will require us to move forward into a just space. While there is an interdependence between human wellbeing and planetary wellbeing (which will be explored in greater depth in Chapter 2), for Raworth (2012, p. 7): “The first priority must be to ensure that all people are free from such deprivations, and are empowered with the rights and resources needed to provide a social foundation for leading lives of dignity, opportunity, and fulfilment.”

Similarly, the SDG framing document, Transforming our World (UN 2015b, p. 3), articulates a commitment to ‘People’ as follows: “We are determined to end poverty and hunger, in all their forms and dimensions, and to ensure that all human beings can fulfil their potential in dignity and equality and in a healthy environment.”

This chapter examines this social foundation from an educational perspective, in terms of the development sectors most closely associated with people and their physical, mental, emotional, and social wellbeing; namely, health, nutrition, water and sanitation (WASH). The purpose of this chapter is to explore the relationship between education and these development sectors.¹ The chapter is divided into the following four sections:

1. education and health;
2. education and nutrition;
3. education and water, sanitation, and hygiene (WASH); and
4. promoting individual wellbeing through education.

It should be noted that much of the literature exploring education and wellbeing is focused on learners. Teachers are rarely the subject of these bodies of research, and when they are, they are most often treated as an input to the education system, rather than as agents and, importantly, rights-holders within development. When it comes to the development agenda itself, the only mention made of teachers in the SDGs is in Target 4c, which discusses ensuring a sufficient “supply” of teachers at different education levels.

1.2 Education and health

1.2.1 The relationship between education and health

Given the ‘within-sector’ thinking that has dominated the development agenda to date, alongside one of the key themes highlighted in this book, that education has traditionally been under-prioritised and under-financed in the development agenda, health professionals, researchers, and policy makers often fail to recognise that education can itself be a key direct or indirect health intervention which can have a positive impact on the health status of individuals and their communities (UNESCO and EFA GMR 2014). First, at the level of health determinants, or contextual factors that play a role in determining health status, numerous studies have shown that education impacts lifestyle and behaviours, as well as occupation choice and success (KC and Lentzner 2010; Luy et al. 2011), and that it can also have a positive impact on socioeconomic status (in the long term) and care of the environment (McMahon 2009). Second, at the level of health system inputs and processes, education primarily has an impact on human resource development, production and dissemination of information, and the capacity of health system users to access and benefit from healthcare. Third, when it comes to outputs and outcomes from the healthcare system, early childhood centres, schools, and other educational institutions can ensure better coverage of health services by providing useful delivery platforms for vaccination programmes, sexual and reproductive health services, counselling and other mental health programmes, etc. These and other ideas will be discussed in more detail below.

Recent research has demonstrated a strong link between poor mental and physical health in adolescence and the disruption of educational attainment and employment pathways (Hale et al. 2015). What is under-researched and consequently less well understood is how lack of access to education (or access to education of poor quality) impacts mental and physical health, though there is emerging research happening in this area. For example, recent medical research suggests that education (particularly at higher levels) actually protects brain functioning against trauma and degeneration. Schneider et al. (2014) examined patients who suffered moderate to severe traumatic brain injury and found a linear relationship between educational attainment and disability-free recovery. Compared to people who did not complete the upper-secondary level of education, those with at least a college education are seven times more likely to recover from traumatic brain injury without any disability. A meta-analysis of 26 studies that investigate different cognitive outcomes after traumatic brain injury confirms that a higher level of education is associated with better outcomes (Mathias and Wheaton 2015). Further, a meta-analysis of 69 studies on education and dementia reported a higher risk of developing dementia among subjects with low education than among individuals with higher levels of education (Meng and D’Arcy 2012). Globally, healthy life expectancy (HALE) is increasing, though more slowly than life expectancy, with the number of healthy years lost to disability on the rise in most countries. While substantial progress has been made in the reduction of mortality since the Millennium, little progress has been made in combatting the overall effect of non-fatal disease, injury, etc., on the health of populations. The concept of HALE will be a useful indicator for monitoring health gains in relation to the sustainable development agenda (Salomon et al. 2012). More and better research is needed, therefore, to demonstrate more concretely how education can contribute to an increase in HALE.

1.2.2 Promising educational interventions for improving health service delivery

The World Health Organization (WHO) estimates that there is a critical shortage of 7.2 million doctors, nurses, midwives, and other health professionals around the world today. As our current health workforce is ageing, and advanced practitioners, midwives, and auxiliaries remain underutilised, by 2035, the world will be short of 12.9 million healthcare workers unless drastic measures are taken (WHO 2013). This human resource crisis has been called one of the most pressing health issues facing the world today (Aluttis et al. 2014), with over 60 percent of countries below the threshold of 59.4 skilled health professionals per 10,000 people (WHO 2013). The crisis is truly global in nature: while it is much more pronounced in Africa and parts of South-East Asia (where most countries with a density of skilled health professionals of less than 22.8 per 10,000 people and a coverage of births by skilled birth attendants below 80 percent are located), high-income countries (HICs) are also affected, with the European Commission estimating a shortage of 2 million by 2020, and Japan and Australia both reporting problems with health systems staffing. Further, these shortages in HICs will compound problems with the health systems in low- and middle-income countries (LMICs) through the so-called ‘brain drain’ phenomenon, where health workers choose to practise in a country other than their own, because they perceive there to be better working conditions in the destination country (Aluttis et al. 2014). Further, currently 11 countries in Sub-Saharan Africa have no medical schools (Seed Global Health 2015), which means that individuals from those countries who wish to train as health professionals have to move abroad, and once there, very few return to practise medicine in their home countries. Within countries such as South Africa, disparities exist too, with rural areas bearing the brunt of shortages and facing the challenge of a brain drain of skilled workers to the urban areas (Burch and Reid 2011).

The education sector has a key role to play in countering this crisis and the other obstacles to meeting the sustainable development targets in a number of direct and indirect ways. First, the tertiary education sub-sector needs to engage with the health sector, ensuring not only that higher and further education and training opportunities in health are available in all countries, in both urban and rural areas, but also that essential pedagogical and curricular reforms occur to improve the quality of health professional education, including community health worker training programmes (Cancedda et al. 2015; WHO 2013). Second, according to the WHO, there is a shortage of trained researchers working in the area of health systems research, so new and innovative approaches to research training will need to be explored (WHO n.d.). Third, the access to and quality of secondary education needs to be expanded to ensure that students leave secondary school with the necessary knowledge and skills to pursue further education as health professionals. Finally, schools and educational institutions can prove to be valuable partners in attempting to reach universal health coverage (Macnab, Gagnon and Stewart 2014). Examples of some of these types of promising educational innovations are discussed below.

Innovative partnerships for health professional education

According to recent research by key health experts, health professional training initiatives in low-income countries (LICs) have had limited impact for a number of reasons, including inefficient use of funding, lack of scale-up, too little emphasis on practical skills acquisition, a lack of alignment with local priorities, and limited coordination. A more in-depth analysis of the educational component of these initiatives reveals some troubling findings: many initiatives are dominated by more traditional pedagogies, such as short-term lectures and seminars, which do little to teach the diversity of skills necessary for health professionals today. Further, health curricula have tended to privilege individual learning over collaborative learning, which runs counter to the actual situation on the ground, where teamwork is essential. Finally, many initiatives focus on the training of clinicians, neglecting to educate other health professionals, including community health workers, midwives, public health professionals, health managers, and, importantly, researchers (Cancedda et al. 2015). These health experts identify four recent innovative training initiatives in Africa, funded by the US Government: the Medical Education Partnership Initiative (MEPI),² the Nursing Education Partnership Initiative (NEPI),³ the Rwanda Human Resources for Health Program (HRH Program),⁴ and the Global Health Service Partnership (GHSP).⁵ They argue that the best practices adopted by these initiatives include country ownership and alignment to local priorities, institutional capacity strengthening and competency-based training through pedagogical and curricular reform, and sustainable partnerships with international stakeholders.

Of these initiatives, the Human Resources for Health Program in Rwanda (launched in 2012) deserves special mention for the reciprocal nature of the partnership between a lower-income country and a higher-income country. It deploys approximately 100 faculty members from different universities and colleges in the United States to Rwanda every year to partner with Rwandan faculty-member counterparts in direct academic and clinical teaching through a ‘twinning’ model, which facilitates curriculum development, clinical pedagogy, service delivery, and research capacity (Binagwaho et al. 2013). This model enables scholarly collaborations between Rwanda and the United States, which creates a space for learning on both sides for clinical innovation and service delivery.

Curricular and pedagogical reform in medical and health education

South Africa faces serious health worker shortages, particularly in the rural areas and public sectors and there are major problems with health sciences education. According to Burch and Reid (2011), a number of key reforms within health education would ensure that rural healthcare centres are staffed by well-qualified health professionals. One such reform is replacing short placements with longer-term placements, a strategy which has proved successful according to emerging evidence from Australia, Canada, and the United States. Such placements are an important pedagogical tool, allowing students to integrate their knowledge and skills (Irlam et al. 2009). Further, general education research has demonstrated the importance of coherence between curriculum (what is taught), pedagogy (how it is taught), and assessment (how learning is measured) (Carr et al. 2005). In South Africa (and in health education programmes around the world), there is often a disconnect between what is taught (skills in district-level facilities) and how it is assessed (assessments are conducted at tertiary teaching hospitals), which undermines the overall learning experience (Bu...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword: universal education as the root cause of sustainable development
• Preface
• Acknowledgements
• List of abbreviations
• Introduction: education in, through, and for sustainable development
• 1 People: enabling physical, mental, and socioemotional wellbeing
• 2 Planet: ensuring environmental sustainability and equity
• 3 Prosperity: building inclusive, sustainable communities
• 4 Peace: establishing positive peace and stable societies
• 5 Partnership: promoting equitable networks for sustainable development
• Conclusion: looking within, across, and beyond the five Ps of sustainable development
• Index